My morning started with a breakfast buffet at the Family Medicine conference. Now, I wouldn’t normally write about a hotel breakfast buffet, but I was struck by the difference between a medical conference and a medical student conference. Let me just say that I can get used to this. There was crab at the afternoon reception.
The conference programming started with a long-time Washington staffer going over the current Congressional dynamics. Short version: “You wouldn’t have had much luck getting anything done with this Congress, even if Osama Bin Laden wasn’t killed last week. But good luck.”
Not surprisingly, there isn’t a lot of compromise in the D.C. air, but the speaker did bring up some interesting issues. Over half of the representatives in Congress have had absolutely no government experience. Now, that may seem like a good thing to some of you (we're all sick of the usual Washington gridlock), but it's actually pretty terrifying when you think about it.
The speaker said that the freshman members of this Congress are on a mission from God, and they only care about a couple of pet issues. They are in Congress to lower the deficit and to repeal healthcare reform at any cost. (Ironically, the healthcare reforms have done more to lower the deficit than any other piece of legislation has in the last decade, but don’t try to tell them that.)
Not surprisingly, there isn’t a lot of compromise in the D.C. air, but the speaker did bring up some interesting issues. Over half of the representatives in Congress have had absolutely no government experience. Now, that may seem like a good thing to some of you (we're all sick of the usual Washington gridlock), but it's actually pretty terrifying when you think about it.
The speaker said that the freshman members of this Congress are on a mission from God, and they only care about a couple of pet issues. They are in Congress to lower the deficit and to repeal healthcare reform at any cost. (Ironically, the healthcare reforms have done more to lower the deficit than any other piece of legislation has in the last decade, but don’t try to tell them that.)
The new members are not particularly interested in hearing about why we need to shift more residency positions from specialties to primary care, or why the single-doctor medical practice is becoming a relic of 1970s TV shows. But good thing for us that there are still a handful of people left in Congress that do want to hear about these things.
Our speakers throughout the rest of the day went over everything from the current state of medical education to the value of primary care in the US healthcare system. And let me tell you, if I wasn’t already in love with becoming a family doc, I would be after yesterday. Here are some of the pearls:
Family Doctors provide 50% of all medical care in the U.S., and do so with only 35% of the physician workforce.
Investments in primary care pay 2 to 1, meaning that if a health facility or insurer pays $1,000 to increase primary care services, it will save $2,000 that same year. And this is very conservative data from Blue Cross/Blue Shield. The Academy of Family Physicians says that this number is actually significantly higher.
Restructuring Medicare to be more primary care focused would not only save Medicare the cost of the restructuring, but also the entire cost of primary care. Read that again: if Medicare would make some small changes (like tying physician payment to the outcome of their patients, and paying for more frequent check ups by physicians and nurses), Medicare would effectively remove the entire cost of primary care from of their books. The good news is that Medicare has already started making these changes. Thank you, President Obama. There’s a reason that the Affordable Care Act (healthcare reform) was 2,000 pages long. This isn’t simple stuff.
For anyone more interested in that last point, Google “Accountable Care Organizations”. That’s the new buzz phrase that people are using to talk about these restructured primary care services. These “ACOs” are essentially home bases for patients’ medical care. Need a check up? Go to an ACO (your primary care doctor). Need surgery? You’d still go to a hospital, but the report would also be sent to your primary care doctor. The only thing different between an ACO and a regular doctor’s office is that the primary doctor is held ‘accountable’ in an ACO. This means that if your doctor does a poor job helping you reduce your cholesterol and you need to go in for heart surgery, the doctor’s pay takes a hit. And conversely, if a doctor’s patients are doing really well and have fewer chronic diseases, that he or she receives a pay bonus. It’s a very simple concept, but it is almost impossible to implement in a healthcare system that rewards doctors for doing a bunch of extra procedures and unnecessary surgeries. However, pilot projects that are experimenting with this concept are already saving Medicare millions of dollars. Again, thank you, President Obama.
Want to be in a bad mood? Keep reading the next two paragraphs. Showing where their true priorities lie, the insurance companies are fighting ACOs tooth and nail. They say (and they’re right) that more ACOs would lead to better primary care, which would lead to fewer hospitals, since there would be less need for high-level care if health problems are treated before they become huge issues. You’d think that the insurance companies would like this, since it will cost them less money in hospital payments. But they’re worried that fewer (and therefore more powerful) hospitals will no longer put up with the bullying that they receive from the insurance companies.
Insurance companies pay hospitals based on a percentage of Medicare rates. In some cases, insurance companies pay as little as 51% of the Medicare rate for the services that hospitals provide (and it's not like the Medicare rates are all that high to begin with). If a hospital doesn’t like that payment arrangement, the insurance companies will just funnel their patients to a nearby hospital, and the protesting hospital is shit out of luck.
The insurance companies are claiming that ACOs will lead to hospital monopolies, and are using federal antitrust laws to fight them. That’s right, the same laws that were used to break up the railroad, oil and communication monopolies are being used to fight better primary care. And here’s the kicker, there are two industries that are exempted from Federal antitrust laws: professional baseball and health insurance. So it’s fine for the insurance companies to consolidate their operations, but it’s not ok for doctors’ offices to do the same.
Our speakers throughout the rest of the day went over everything from the current state of medical education to the value of primary care in the US healthcare system. And let me tell you, if I wasn’t already in love with becoming a family doc, I would be after yesterday. Here are some of the pearls:
Family Doctors provide 50% of all medical care in the U.S., and do so with only 35% of the physician workforce.
Investments in primary care pay 2 to 1, meaning that if a health facility or insurer pays $1,000 to increase primary care services, it will save $2,000 that same year. And this is very conservative data from Blue Cross/Blue Shield. The Academy of Family Physicians says that this number is actually significantly higher.
Restructuring Medicare to be more primary care focused would not only save Medicare the cost of the restructuring, but also the entire cost of primary care. Read that again: if Medicare would make some small changes (like tying physician payment to the outcome of their patients, and paying for more frequent check ups by physicians and nurses), Medicare would effectively remove the entire cost of primary care from of their books. The good news is that Medicare has already started making these changes. Thank you, President Obama. There’s a reason that the Affordable Care Act (healthcare reform) was 2,000 pages long. This isn’t simple stuff.
For anyone more interested in that last point, Google “Accountable Care Organizations”. That’s the new buzz phrase that people are using to talk about these restructured primary care services. These “ACOs” are essentially home bases for patients’ medical care. Need a check up? Go to an ACO (your primary care doctor). Need surgery? You’d still go to a hospital, but the report would also be sent to your primary care doctor. The only thing different between an ACO and a regular doctor’s office is that the primary doctor is held ‘accountable’ in an ACO. This means that if your doctor does a poor job helping you reduce your cholesterol and you need to go in for heart surgery, the doctor’s pay takes a hit. And conversely, if a doctor’s patients are doing really well and have fewer chronic diseases, that he or she receives a pay bonus. It’s a very simple concept, but it is almost impossible to implement in a healthcare system that rewards doctors for doing a bunch of extra procedures and unnecessary surgeries. However, pilot projects that are experimenting with this concept are already saving Medicare millions of dollars. Again, thank you, President Obama.
Want to be in a bad mood? Keep reading the next two paragraphs. Showing where their true priorities lie, the insurance companies are fighting ACOs tooth and nail. They say (and they’re right) that more ACOs would lead to better primary care, which would lead to fewer hospitals, since there would be less need for high-level care if health problems are treated before they become huge issues. You’d think that the insurance companies would like this, since it will cost them less money in hospital payments. But they’re worried that fewer (and therefore more powerful) hospitals will no longer put up with the bullying that they receive from the insurance companies.
Insurance companies pay hospitals based on a percentage of Medicare rates. In some cases, insurance companies pay as little as 51% of the Medicare rate for the services that hospitals provide (and it's not like the Medicare rates are all that high to begin with). If a hospital doesn’t like that payment arrangement, the insurance companies will just funnel their patients to a nearby hospital, and the protesting hospital is shit out of luck.
The insurance companies are claiming that ACOs will lead to hospital monopolies, and are using federal antitrust laws to fight them. That’s right, the same laws that were used to break up the railroad, oil and communication monopolies are being used to fight better primary care. And here’s the kicker, there are two industries that are exempted from Federal antitrust laws: professional baseball and health insurance. So it’s fine for the insurance companies to consolidate their operations, but it’s not ok for doctors’ offices to do the same.
I told you not to read those last two paragraphs.
But all told, I had a much better time discussing health policy than any rational person should have had. And the headliner at yesterday's event? Not U2, not Justin Bieber, but the one and only director of Medicare.
The crowd went wild.
-M
But all told, I had a much better time discussing health policy than any rational person should have had. And the headliner at yesterday's event? Not U2, not Justin Bieber, but the one and only director of Medicare.
The crowd went wild.
-M
P.S. No politics in the next post. I promise!
